Diagnostic evaluation of a 38-year-old woman with NSTEMI identified a focal occlusion of a septal perforator branch and a large patent foramen ovale, prompting outpatient PFO closure.
Case Report (n=1)
This case highlights the importance of evaluating for nonatherosclerotic etiologies, such as paradoxical embolism via PFO, in young patients presenting with NSTEMI.
BACKGROUND: Myocardial infarction in young patients without traditional cardiovascular risk factors raises concern for nonatherosclerotic etiologies such as spontaneous coronary artery dissection and coronary embolism. CASE SUMMARY: A 38-year-old woman with no past medical history presented with acute substernal chest pain associated with nausea and vomiting. Evaluation was consistent with non-ST-segment elevation myocardial infarction (NSTEMI), with dynamic elevation in high-sensitivity troponin levels and ischemic electrocardiographic changes. Transthoracic echocardiography demonstrated mildly reduced left ventricular systolic function with regional wall motion abnormalities not confined to a single coronary distribution as well as a large right-to-left interatrial shunt with atrial septal aneurysm. Coronary angiography identified focal occlusion of a septal perforator branch of the left anterior descending artery. She was managed with guideline-directed NSTEMI therapy and later underwent outpatient patent foramen ovale closure. DISCUSSION: This case illustrates the diagnostic complexity of NSTEMI in young patients when angiographic findings and cardiac imaging suggesting nonatherosclerotic etiologies. TAKE-HOME MESSAGE: NSTEMI in young patients warrants standard acute coronary syndrome management while concurrently evaluating for alternative mechanisms of myocardial injury.
Narendran et al. (Fri,) conducted a case report in Non-ST-segment elevation myocardial infarction (NSTEMI) (n=1). Guideline-directed NSTEMI therapy and patent foramen ovale closure was evaluated. Diagnostic evaluation of a 38-year-old woman with NSTEMI identified a focal occlusion of a septal perforator branch and a large patent foramen ovale, prompting outpatient PFO closure.